急性结石性胆囊炎腹腔镜胆囊切除术术前评分模型的建立

目的:建立急性结石性胆囊炎腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术前评分模型,预测手术难度。方法:回顾分析2014年6月至2016年6月324例急性结石性胆囊炎患者行LC的临床资料,并根据手术时间分为容易组与困难组。应用χ~2检验对两组指标进行单因素分析;再将P<0.01的指标纳入多因素Logistic回归分析。采用多因素分析有统计学意义(P<0.05)的指标构建LC术前评分模型,并应用ROC曲线评价此模型的性能。结果:单因素分析表明,性别、胆囊炎发作时间、凝血酶原时间、中性粒细胞绝对计数、纤维蛋白原、碱性磷酸酶及胆囊壁厚度对手术时间具有影响;多因素分析表明,性别、胆囊炎发作时间、中性粒细胞绝对计数、碱性磷酸酶、纤维蛋白原及胆囊壁厚度是影响手术时间的独立危险因素。LC术前评分模型的曲线下面积为0.784。以5分为手术是否困难的临界值,其特异度为72.7,敏感度为80.6。结论:LC术前评分模型对预测LC手术难度具有较好的预测能力,可为选择合适的手术方式提供临床指导。

Establishment of a risk scoring model to predict difficulties in patients with acute calculous cholecystitis undergoing laparoscopic cholecystectomy

Objective:To establish a risk scoring model to predict the difficulties in patients with acute calculous cholecystitis (ACC) undergoing laparoscopic cholecystectomy (LC) and choose the right surgical procedures.Methods:The clinical data of 324 patients with ACC who underwent LC were retrospectively analyzed from Jun.2014 to Jun.2016.These patients were divided into easy or difficult group according to the operation time and a univariate analysis was performed by chi-squre test between the two groups.Significant variables (P<0.01) were then included into a multivariate logistic regression model.Variables that remained in the final logistic regression analysis (P<0.05) were used to build a LC preoperative scores model and the predictive value of this model was validated using receiver operating characteristic curves.Results:Univariate analysis indicated the following seven factors to be associated with operating time:gender,time of cholecystitis attack,prothrombin time,neutrophil count,fibrinogen,alkaline phosphatase and gallbladder wall thickness.Among them six were independent factors predicted by multivariate logistic regression analysis:gender,time of cholecystitis attack,neutrophil count,alkaline phosphatase,fibrinogen and gallbladder wall thickness.The area under the receiver operating characteristic curve of the LC preoperative scores model was 0.784.When a score of 5 for LC preoperative scores model was set as the cutoff value for operating difficulties,the sensitivity was 80.6% and the specificity was 72.7%.Conclusions:The LC preoperative scores model has a good predictive capacity for operating difficulties and can provide clinical guidance for choosing a suitable operation method.